In this Wednesday, March 5, 2014 file photo, a doctor holds a model of a tri-compartmental total knee replacement in Chicago. (AP Photo/M. Spencer Green)

It has been said that, “All would be well if there were no buts.” Unfortunately, life is full of “buts.” A prime example is joint surgery.

Today, an increasing number of people are being relieved of chronic pain by hip and knee replacements. Others are being helped by lesser laparoscopic procedures. But patients should be aware that these are major operations sometimes associated with unintended consequences.

For instance, several years ago, Dr. Justin de Beer, an orthopedic surgeon at the Henderson site of Hamilton Health Services in Hamilton, Ont., reported this unexpected finding: A worrying number of patients after hip and knee replacements had suffered heart attacks following the operation.

The majority of these coronary attacks occurred within three to five days of the replacement. Equally important, 29% of these patients had no previous history of cardiac disease.

To obtain this information Dr. de Beer and his colleagues analyzed 3,471 hip and knee replacements performed at their hospital from 1998 to 2003. They found that 63 patients had suffered a heart attack and 7 patients died.

Another study showed a 12% rate of silent heart attacks after surgery for non-cardiac conditions. Moreover 60% of these patients experienced another major cardiac problem within the next six months.

Several other studies, one published by the Canadian Medical Association Journal in 2006, showed a significant downside to elective surgical procedures. In this study, 1.4% of patients over 50 years of age suffered major cardiac problems when they were not having surgery on their heart. Of these patients who had a heart attack, 25% died, and for those who had a cardiac arrest during surgery, 65% died.

Looking at the problem from a worldwide standpoint the figures are more shocking. Of the 100 million operations done for non-cardiac reasons 900,000 patients died from heart attack, suffered a non-fatal coronary or had a non-fatal cardiac arrest during the surgery!

But why are patients developing heart problems during surgery? Remember, these patients having hip and knee replacements are not kids. One study showed that patients at greatest risk for a heart attack, even a silent one, are over the age of 50, suffering from diabetes, or have both a knee and hip replacement done at the same time.

The blunt fact is that it’s impossible to provide new joints without placing the body under extreme stress.

Moreover, the trauma of the surgery triggers a host of physiological changes that increases the risk of a fatal blood clot.

But what about the risk of what’s often referred to as keyhole surgery that is much less traumatic? These procedures can also greatly improve quality of life. But a report in “The Risk Management Magazine,” published by the Canadian Medical Protective Assoc., shows even these lesser operations can be associated with significant risks.

For example, some were left with either temporary or permanent impairment that resulted in significant loss of function. Some patients complained of foot drop, a change in the length of their leg or continued persistent pain.

Others suffered from infection, blood clots in the leg, lungs or stroke. Still others had the sciatic nerve injured. A few surgeons operated on the wrong leg! And seven percent in this study died.

So never forget this Gifford-Jones Law. If a joint is partially broken and causing only minor discomfort, think twice or a few times before agreeing to surgery. Surgery is best done only when joint pain is having a major effect on one’s quality of life.

Also, be an informed patient. Some patients complained they had not been advised of all possible complications. So be certain to have a discussion about side-effect before the procedure. And also have the surgeon place his initials on the affected joint to avoid wrong-sided surgery.

You must also accept the fact that if you’re obese, have diabetes, hypertension or other medical problems, you always face a greater risk of complications. And that even under the best of conditions, no surgeon can ever guarantee there is no chance of complications. There will always be “buts” in surgery.

EDITOR'S NOTE: The column does not constitute medical advice and is not meant to diagnose, treat, prevent or cure disease. Please contact your doctor. The information provided is for informational purposes only and are the views solely of the author.